- Partnering for Change (P4C) is an innovative, evidence-informed model that guides the delivery of rehabilitation services in school settings. The partnership involves educators, families, children and therapists collaborating to promote participation at school by changing daily activities, as well as the physical, social and learning environments, of children with special needs.
- The goals of P4C include early identification of children with special needs; building capacity of educators and families to understand and manage children’s needs; preventing secondary consequences and facilitating self and family management; and improving children’s ability to participate successfully in school, the community and at home.
- Health professionals — who in this study were occupational therapists — provide services in schools within a needs-based, tiered, response-to-intervention pyramid model. Services are offered along a continuum, which has the advantage of reaching many students who have not been identified yet while still providing students who have more complex needs with more individualized services. The therapist is present on a regular basis so students’ responses to services are monitored regularly and adjusted as needed.
- P4C services include: class-wide health promotion and learning designed to help all students; small group screening and differentiated instruction; monitoring of children’s responses and progress; collaborative problem-solving with educators to identify strategies and accommodations that improve participation of individual children; knowledge translation to educators to facilitate changes to physical, social and learning environments in schools; sharing strategies with and supporting families.
- Created by researchers at CanChild Centre for Childhood Disability Research and supported by the leadership of Cathy Hecimovich, CEO of the Central West Community Care Access Centre (CW CCAC), P4C was developed and tested using a participatory action research process. This process involved key stakeholders from government, health care decision-makers, occupational therapists, service provider organizations, schools, and families.
- Funded by the Ontario Ministry of Health and Long-Term Care, and the Ministry of Education, the P4C service model was implemented and evaluated from 2013–15 across three school boards within two CCACs (Central West and Hamilton Niagara Haldimand Brant).
- Fifteen occupational therapists (OTs) worked one day per week in 40 schools in Year 1; seventeen OTs worked one day per week in the same 40 schools in Year 2.
It has been an amazing experience having the OT here to work with the many students in my class. Without her support, my students would not have developed an increased sense of self-confidence. They are beginning to feel success in many areas not just academic. This is a life-changing service that is provided.— Educator
- Educators valued having an OT in the school on a regular basis. Because every school had its own context and culture, we learned that the OTs needed time for relationship building and knowledge translation before moving to more individualized services.
- OTs were valued by educators because they were a consistent presence in the school. Educator capacity was built incrementally across the two-year period.
- P4C was an equitable service, reaching all children and families, including those who do not speak English, who are living below the poverty level, or had parents or family members working full-time.
- While more work is needed to reach and build the capacity of parents, those parents who interacted with the OT were extremely satisfied and used the resources that were provided.
- Results indicate that P4C, as delivered in this study, facilitates equal access to services, eliminates wait lists at no additional cost, and serves large numbers of children with a diverse array of special needs.
- Children were identified earlier, served earlier, and children with many different types of special needs were able to be served.
- Children in the study showed improvements in all areas of school participation and also greater participation in many activities at home and in the community.
- Parents reported a decrease in their child’s overall emotional and behavioural problems. Parents also reported a reduction in inattention and hyperactivity.
- Occupational therapists increased their skills and knowledge, particularly in their first year of providing P4C. They emphasized the time it took to transition to this model and the paradigm shift that is required in their practice. There is a strong need for training and mentorship of the OTs, which they valued and indicated was pivotal in their ability to implement this model successfully.
- The OTs experienced job satisfaction as a result of feeling part of the team, seeing the difference they were making and the ability to work to their full scope. This should lead to greater retention of experienced OTs in schools.
- Process maps documenting the pathway followed by children receiving OT services showed a dramatic reduction in the time and cost with regard to the number of people who need to be involved in the referral process. There are far fewer steps in P4C and there are more “value added” steps for the family.
- The many stakeholders involved in the research and implementation of this service model have indicated that the core principles and features of P4C are relevant to other health professionals and to development of an integrated framework for rehabilitation service provision in Ontario.
- Positive results in the 2013–14 year led the CW CCAC to expand provision of P4C to two additional school boards in the second year. In 2015–16, OTs will be delivering P4C in additional schools and school boards within both CCACs, demonstrating sustainability and the potential for this model to spread beyond the current research study.
A webinar is available that provides more detail about P4C and its relevance to the Ontario Special Needs Strategy.